MDCAST: High-Risk PE: Inside the New Guidelines

About this episode

This episode discusses the new 2026 pulmonary embolism guidelines focusing on critical care and transport clinicians' management of high-risk patients.

This episode reviews the newly released 2026 pulmonary embolism guidelines with an emphasis on what matters most for critical care and transport clinicians: identifying the sickest PE patients early and recognizing how quickly they can deteriorate. Dr. Michael Lauria stresses that although pulmonary embolism is common, the subset with hemodynamic instability carries very high mortality and often requires transfer for advanced therapies such as ECMO, catheter-based intervention, or surgery. A major focus is the new classification system, which replaces the older “massive” and “submassive” terminology with categories A through E. Instead of emphasizing clot size, the new framework centers on clinical severity, especially hypotension, end-organ hypoperfusion, and progression toward cardiopulmonary failure. The episode also highlights that severe PE is fundamentally a problem of right ventricular failure: as pulmonary vascular resistance rises, the RV dilates, perfusion worsens, LV filling drops, and the patient can spiral into shock. Management is therefore framed around supporting the failing RV while moving toward definitive reperfusion. The speaker recommends maintaining…

People in this episode

Guest: Dr. Michael Lauria

Topics covered

• pulmonary embolism
• critical care
• transport medicine
• guidelines
• hemodynamic instability
• right ventricular failure

Keywords

• pulmonary embolism
• guidelines
• critical care
• hemodynamic instability
• right ventricular failure
• ECMO
• catheter-based intervention
• surgery

Mentioned in this episode

Organizations: FlightBridgeED, ECMO, MDCAST, Long Pause Media

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